Article Impact Level: HIGH
Data Quality: STRONG
Summary of JACC https://doi.org/10.1016/j.jacc.2025.07.069
Dr. Rebecca Josowitz et al.
Points
- Cost-related insulin rationing rates remained largely unchanged, at approximately 24%, between 2017 and 2024.
- One hundred ninety-nine respondents participated in both the 2017 and 2024 cross-sectional surveys, ensuring consistent comparison.
- In 2024, seventy-five participants (37.7%) reported broader insulin rationing due to various access barriers, including cost and supply issues.
- Patients with type 2 diabetes exhibited significantly lower odds of rationing (OR 0.34, 95% CI 0.13–0.87) compared to those with type 1 diabetes.
- The study highlights the persistent need for comprehensive solutions addressing insulin affordability and access despite recent policy changes.
Summary
This repeated cross-sectional study investigated the persistent issue of insulin rationing due to access barriers—including cost, insurance delays, and pharmacy shortages—among insulin-prescribed patients with diabetes. The study compared findings from a 22-item survey conducted from April to July 2024 with a similar survey from June to August 2017 at the Yale Diabetes Center. The objective was to ascertain whether recent policy changes aimed at limiting insulin out-of-pocket costs have successfully translated into reduced rationing rates.
In 2024, among 199 respondents (mean age 52.4 years, 47.7% female, 58.3% white, and 47.2% with type 1 diabetes), 48 patients (24.1%) reported cost-related insulin rationing. This rate remained statistically unchanged compared to 2017, when 51 patients (25.5%) out of 199 respondents reported cost-related rationing (p = 0.41). Although participant characteristics reporting cost-related rationing remained similar between years, a higher proportion of adults with type 1 diabetes reported rationing in 2024 (63.0%) compared to 2017 (43.1%, p = 0.05).
Beyond cost, in 2024, 75 participants (37.7%) reported broader insulin rationing attributed to cost, insurance delays, or pharmacy shortages. A multivariable model revealed that age, sex, race, ethnicity, income, and insurance coverage were not significantly associated with rationing. However, patients with type 2 diabetes exhibited significantly lower odds of rationing (odds ratio 0.34, 95% confidence interval 0.13–0.87) compared with type 1 diabetes patients. These findings underscore that despite recent policy interventions, insulin rationing remains a prevalent issue, particularly for those with type 1 diabetes, emphasizing the ongoing necessity for comprehensive solutions addressing insulin affordability and access.
Link to the article: https://link.springer.com/article/10.1007/s11606-025-09886-9
References
Josowitz, R., Woyciechowski, S., Jadhav, T., Jammihal, T., Linn, R. L., Rychik, J., Gaynor, J. W., Rajagopalan, R., & Spinner, N. B. (2025). Placental malperfusion is associated with adverse outcomes in congenital heart disease and with genetic variants in placental developmental pathways. JACC, 86(19), 1704–1720. https://doi.org/10.1016/j.jacc.2025.07.069
